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Edit 01338
Recipient not on Restricted Recipient File
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N30
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: QC
Potential Causes:
The service billed requires that the client be placed on the Restricted Client File by the Department of Social services. The client’s file must then contain the proper coding to allow payment.
Solution:
Check the Rate Code entered to ensure that the correct service was billed. Ensure that the correct Client ID was submitted. If necessary, contact the Department of Social Services to have the Client placed on the Restricted Client file. Enter the data in the loops and the segments provided and resubmit.
| 837 Institutional |
| Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Cient ID Number (Subscriber Primary Identifier)
Loop 2300, HI (Value Information)
HI01-1 = BE (Code List Qualifier Code)
HI01-2 = 24 (Value Code)
HI01-5 = 4 Digit Rate Code (Value Code Associated Amount)
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